Provider Demographics
NPI:1659903599
Name:SAMRA-THEURER, ANN M (BSDH, OMT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:SAMRA-THEURER
Suffix:
Gender:F
Credentials:BSDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3988 COBBLESTONE CV
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-2078
Mailing Address - Country:US
Mailing Address - Phone:260-403-2827
Mailing Address - Fax:
Practice Address - Street 1:3988 COBBLESTONE CV
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-2078
Practice Address - Country:US
Practice Address - Phone:260-403-2827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-09
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13002201A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist